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Trigeminal neuralgia (TN) is usually caused by vascular compression of the trigeminal nerve root entry zone, but can be caused by other factors such as tumors, vascular disorders, and demyelination in multiple sclerosis. We present a rare case with a huge osteoma located on the cerebellopontine angle (CPA) and causing TN. A 48-year-old woman presented with TN caused by a huge left CPA bone tumor. Surgery was performed by the lateral suboccipital approach under neuronavigation system guidance and regional decompression of the trigeminal nerve root entry zone was achieved. Intraoperative, neuro-navigation system was very useful for identification of the trigeminal nerve entry zone because normal anatomy had been obscured by the huge osteoma. Her pain disappeared completely immediately after surgery. The histological diagnosis was osteoma. TN is an expectative symptom of CPA tumors. Osteomas should be considered in patients with CPA tumors.